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VCU Massey Cancer Center


Communication with doctors is critical to early, accurate colorectal cancer diagnosis

If you present symptoms of colorectal cancer, open and direct communication with your physician could save your life, suggest the results of a study by researchers at Virginia Commonwealth University Massey Cancer Center.

Colorectal cancer (CRC) is the second leading cause of cancer death in the U.S., but if diagnosed early, patients have a five-year survival rate of 91 percent. In a study recently published in the journalPatient Education and Counseling, Laura A. Siminoff, Ph.D., and a team of researchers conducted in-depth interviews with 242 patients diagnosed with CRC in the six months preceding the study. Interview responses, confirmed by a review of the participants’ medical records, identified several factors that contribute to diagnostic delay. Diagnostic delay refers to the time from the first visit in which the patient reports symptoms indicative of CRC through the date of diagnosis.

“The study highlights the importance of communication between doctors and patients,” says Siminoff, Theresa A. Thomas Memorial Foundation Chair in Cancer Prevention and Control and associate director for the Cancer Prevention and Control program at VCU Massey Cancer Center and professor and chair of the Department of Social and Behavioral Health in the VCU School of Medicine. “By recognizing the factors that delay diagnosis, doctors can probe for relevant social and economic information, assist patients in distinguishing or elaborating on symptoms and provide clear rationale and instructions for future steps.”

Low income, having a regular physician prior to diagnosis, having a physician who delayed diagnosis by investigating more benign causes of the symptoms, receiving an alternate diagnosis, experiencing a delay in referral and experiencing follow-up delay of any kind were factors leading to diagnostic delay greater than two months. Because this was a retrospective study in which the participants needed to recall discussions with their health care providers up to six months after they took place, the researchers stress that causality cannot be inferred.

“The results show that doctors may be having a difficult time recognizing the symptoms of early stage colorectal cancer,” says Siminoff. “The delay associated with having a regular health care provider may be due to these patients seeking medical attention sooner with less acute symptoms, but it also suggests doctors should recognize the potential influence of the preexisting relationship and not jump to conclusions based solely on past history. ”

Moving forward, the researchers plan to analyze the patient records to find symptom clusters associated with early stage CRC diagnoses. They hope this will provide better guidance to primary care physicians. Symptoms of colorectal cancer may include a change in bowel habits that lasts for more than a few days, rectal bleeding, dark stools or blood in the stool, cramping or abdominal pain and a feeling of fatigue.

“Doctors should understand the many factors involved in diagnostic delay and push patients to elaborate on the severity and duration of their symptoms. This communication can be the difference between early and late stage colorectal cancer,” says Siminoff.

Collaborating with Siminoff on this study were Heather L. Rogers, Ph.D., Maria D. Thomson, Ph.D., and Levent Dumenci, Ph.D., from the Department of Social and Behavioral Health at VCU School of Medicine, and Sonja Harris-Haywood, M.D., from Case Western Reserve University collaborated.

The full manuscript is available online at:

Written by: John Wallace

Posted on: July 15, 2011

Category: Prevention & control